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A Persian in Therapy

My people don’t do psychotherapy. We have friends. We have families. We have pharmacies. Paying strangers to listen to our problems isn’t our style.

I’m Persian, made in Iran pre-revolution, born in America mid-revolution, bred in Ohio post-revolution. I place trust in signs, in duty, in divinity — things that psychotherapists often dismiss as incidental, if not superstitious or worse yet, symptomatic. The couch is not the place for me.

But I had little choice. My first hallucinations appeared in college, which would have been unremarkable had it not been for the dearth of drugs in my system. As a (relatively) good Muslim girl who didn’t even drink alcohol, let alone experiment with hallucinogens, I knew something was wrong. It had been easy to chalk up many of my earliest manic and depressive symptoms to adolescent moodiness or too much Morrissey or an artistic spirit — but not the hallucinations. They freaked me out.

Worse, I was already suffering from another illness. A few years before, a tumor had taken up residence in my pancreas and was busy wreaking its own havoc. I had lost count of all the emergency room visits and hospitalizations. Doctors insisted that I maintain a brutally low-fat diet and that ignoring their advice could cause extreme pain, pancreatitis and even death. I used to joke that I could commit suicide by eating a jar of peanut butter, though eventually this idea became less comic relief and more morbid obsession.

That was when I first sought psychotherapy.

It didn’t go particularly well. Despite weekly therapy sessions on and off over the course of a decade, not to mention countless consultations with psychiatrists, my condition was consistently misdiagnosed as unipolar depression (and thus I was often prescribed medications that exacerbated my condition).

All the while, psychotherapy felt foreign to me. It was like an overpriced, undersize sweater woven entirely from steel wool. I desperately wanted it to fit and soften with wear, but it did neither. Once, after I mentioned efforts to pray more, a psychologist suggested doing so would be excessive, having assumed (incorrectly) that I already prayed five times a day. I grew skeptical. Perhaps I wasn’t sufficiently Americanized to benefit from therapy. Perhaps there was just too much Persian pride and pragmatism standing in the way of whatever breakthroughs I was supposed to be making. Perhaps I was terminally displaced, beyond repair.

Whatever the case, all the awkward silences, the how-does-that-make-you-feels, the false cultural assumptions and the utter one-sidedness of the whole psychotherapeutic exchange combined to form a large flashing sign in my mind: You Do Not Belong Here. It was just another part of a cultural narrative that didn’t include people like me.

Eventually, I suffered a psychotic break. This led to a proper diagnosis — bipolar disorder — and better treatment. After being released from the hospital, I found a psychiatrist to manage my medications and vowed to abandon psychotherapy once and for all. I had lost all hope in it. The therapist I’d been meeting with weekly during the year preceding my break told my husband immediately after I was hospitalized that I had a “classic” and “textbook” case of bipolar disorder. How she nonetheless managed to miss such a clear-cut case for more than a year remains a mystery.

To find my way both spiritually and psychologically, I felt I needed to reclaim my own narrative, in my own words, on my own terms — and somehow get people to listen. It was a gastroenterologist and fellow writer, not a psychotherapist or psychiatrist, who initially helped me do this. His name was Howard M. Spiro, and he was the first person who believed enough in my writing to publish it. The piece was an essay called “Half a Pancreas Later, Some Things are Still Hard to Digest,” and it recounted my pancreatic surgery, among other personal misadventures within the American health care system.

Dr. Spiro found a home for it in a publication he had established, the Yale Journal for Humanities in Medicine. For many years, until his death in 2012, he periodically sent me short notes of encouragement after reading something I’d written. His support, personal and professional, helped me begin to heal profound wounds that had seemed impervious to psychotherapy.

Then, more than a decade later, something peculiar happened. After moving to another state, I was in the market for a new psychiatrist. I encountered a doctor who did — and preferred to do — psychotherapy in conjunction with medication management. I liked him, and despite my reservations about psychotherapy, decided to play things by ear, imagining that after a few initial long sessions, we could graduate to routine 15-minute med checks.

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But during those first sessions, he greatly impressed me. Aside from lodging serious critiques of his own profession, he displayed a remarkable capacity for humor, humility and humanity. Unlike previous therapists I’d seen, he was not alarmed by my belief that mysticism and mental illness are not mutually exclusive, that there may be value in certain manic or depressive experiences, not as delusions, but as spiritual lessons. He also seemed less obsessed with labels than any of his predecessors, and he managed to say “I don’t know” at least a dozen times. I’m not sure I’ve ever heard another doctor respond to a direct medical question like that. This fact alone earned him my respect.

But earning my trust would take more. Given my history — both clinical and cultural — I would need a sign.

That’s when his name first struck me: Phillip Spiro. The gastroenterologist Howard Spiro was the only other Spiro I had known, and he had been so kind and encouraging, inadvertently helping me process so much of the trauma tied to my pancreatic tumor. It seemed only fitting that another Spiro might help me process the trauma tied to my psychiatric condition. I didn’t need for the two men to be related; sharing the same last name was sign enough for me.

So having already made my decision to pursue regular weekly therapy with this new Spiro, I asked him — more out of curiosity than judgment — at the end of one of our early sessions, “Are you any relation to the Howard Spiro at Yale?”

“He was my dad,” he replied.

And so another sign emerged, complete with flashing lights of its own. Its message was unmistakable: You Belong Here.

Every Tuesday afternoon since, an entire cultural narrative has shifted slightly, just enough to make room for me.

Melody Moezzi is the author of the memoir “Haldol and Hyacinths: A Bipolar Life.”

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Couch features essays by psychotherapists, patients and others about the experience of therapy — psychoanalysis, cognitive behavioral therapy, group therapy, marriage therapy, hypnotherapy or any other kind of curative talk between people behind closed doors. To contact the editors of Couch, send an email to opinionator@nytimes.com. Please include “Couch” in the subject field.